WASHINGTON STATE CLIENT-CENTERED

PREGNANCY PREVENTION PROGRAMS

OVERVIEW

Seven “client-centered” pregnancy prevention programs were set up in Washington state in the late ‘90s.  An evaluation of these programs’ effectiveness randomly assigned high-risk 9-17 year-olds to a treatment group or a control group.  Treatment students received a client-centered intervention that combined sex education and skills-building with individualized services.

Among pre-teens, one program site had an impact on intent to have sex and a different program site had an impact on intent to use substances, but no significant differences were found between treatment and control pre-teens overall. 

Among teens, significant overall differences were found between treatment and control groups on measures of sexual behaviors and intentions.  Five to nine months into the intervention, teenagers assigned to the treatment group were significantly less likely to have had intercourse during the past month than were students assigned to the control group.  They were also significantly less likely to intend to have sex.

One teenage program site had an impact on contraceptive use and another had an impact on intent to use contraceptives, but the programs had no overall impact on these outcomes.  The programs had no overall impact on educational aspirations, substance use, or sexual values either. 

DESCRIPTION OF PROGRAM

Target population: high-risk 9-17 year-olds

“Client-centered” pregnancy prevention interventions combine sex education and skills-building with a broad array of individualized services, including counseling, mentoring, and advocacy.  These programs also provide links to clinical family planning services and opportunities for clients to participate in social and recreational activities.

These programs aim to be comprehensive.  They address not only sex and STDs, but also drugs and alcohol, values and attitudes, life-planning, goal-setting, and coping skills.  Many client-centered programs use a sex education curriculum, but modify its messages according to the needs of individual clients. 

The motivation for these programs comes from the practitioner wisdom that helping students avoid risky behaviors involves not only informing them about sexual activity and its consequences, but also providing them with consistent emotional support and positive guidance.  Students in client-centered programs have an adult they can trust and confide in – someone they can go to for “real” information about sex. 

EVALUATION(S) OF PROGRAM

McBride, D. & Gienapp, A.  (2000).  Using Randomized Designs to Evaluate Client-Centered Programs to Prevent Pregnancy.  Family Planning Perspectives, 32(5), 227-235.

Evaluated population: Seven different client-centered programs located in seven different communities in Washington state were evaluated in this study.  Four programs served pre-teens (aged 9-13) and three programs served teenagers (aged 14-17).  High-risk 9-17 year-olds were referred to the programs by school counselors, family planning clinics, and other social service agencies.  1,042 students consented to participate in pre-teen programs and 690 students consented to participate in teenage programs.  These students were predominantly white (63%) and female (78%).     

Approach: At each program site, students were randomly assigned to the treatment group or the control group.  Students assigned to the treatment group received their site’s client-centered services; students assigned to the control group did not.  Sites differed in what specific services they offered, but all had educational components and individualized services.  Three of the pre-teen sites provided education and skills-training to both treatment and control students, but did not offer individualized services to control students.  All other sites reserved all aspects of their program for treatment students.  Active parental consent was required for clients under the age of 14.  Site staff included trained sexuality educators, social workers, and counselors.  Each site received $40,000-$50,000 for the year.

The amount of time treatment students spent receiving services varied significantly.  Though education and skills-building were generally provided for a fixed number of hours, the amount of time any given student spent receiving individualized services depended on his/her individual needs.  At pre-teen sites, treatment students received an average of 14 hours of services, while control students received an average of 5 hours of services.  At teenage sites, treatment students received an average of 27 hours of services, while control students received an average of 2 hours of services.  Treatment clients at Site F received 31 hours of services, on average.

All students were surveyed before the intervention began and again 5-9 months later.  These surveys assessed students’ aspirations, values, intentions, and behaviors.  Teenage students were surveyed on their sexual behaviors and contraceptive use, but pre-teens were not.  75% of students completed follow-up surveys. 

Results: Assignment to the treatment group appeared to have no impact on pre-teens overall.  Pre-teens assigned to the client-centered program did not differ significantly from pre-teens assigned to the control group on measures of sexual values, communication with parents, educational aspirations, and substance use.  At one pre-teen site (identified as Site C), treatment students reported significantly less intent to have sex than did control students, but this significant difference was not present at any other pre-teen site, nor among pre-teens overall.  At a different site (identified as Site B), treatment students reported significantly less intent to use substances than did control students, but, once again, this difference was not present at any other pre-teen site, nor among pre-teens overall.

One teenage site (identified as Site F) was particularly successful at impacting the sexual practices of treatment students.  Treatment students at Site F were significantly less likely than control student to report having had intercourse during the past month.  This difference was insignificant at the other two teenage sites, but was significant when all teenage students were analyzed together.  Treatment students at Site F were also significantly more likely than control students to report having used contraception the last time they had sex and to report always using contraception.  These impacts were not present at the other two teenage sites.  No overall significant difference emerged between treatment students and control students on either of these measures. 

A different teenage site (identified as Site E) was successful at impacting the sexual intentions of treatment students.  Treatment students at Site E were significantly more likely than control students to report an intent to abstain from sex and to report an intent to use contraception when engaging in sex.  These intentions did not translate into significantly higher rates of abstinence or contraceptive use, however.  Intent to engage in sex was not measured at Site F and, at the remaining teenage site (Site G), treatment students reported slightly greater intent to engage in sex.  When analyzed all together, treatment students had significantly lower intent to engage in sex than control students.  Differences between treatment and control groups at Sites F and G on intent to use contraceptives were insignificant, as were differences overall. 

Site E was also successful at positively reducing the hard drug use of treatment students. Treatment students at Site E were significantly less likely than control students to use hard drugs; however, at Sites F and G, treatment groups were significantly more likely than control groups to use hard drugs.  Consequently, there was no overall impact of the program on hard drug use.

No significant differences were found between the treatment and control group, overall or at individual programs, on measures of educational aspirations, sexual values, or use of tobacco, marijuana, and alcohol.

The authors suggest that higher doses of services are needed by high-risk adolescents.

SOURCES FOR MORE INFORMATION

Program materials are not available for purchase.

References:

McBride, D. & Gienapp, A.  (2000).  Using Randomized Designs to Evaluate Client-Centered Programs to Prevent Pregnancy.  Family Planning Perspectives, 32(5), 227-235.

Program categorized in this guide according to the following:

Evaluated participant ages: 9-17

Program age ranges in the guide: Middle Childhood, Adolescence, Youth

Program components: Mentoring/tutoring, Counseling/therapy, School-based, Clinic/provider-based, Service/vocational learning

Measured outcomes: Reproductive Health, Behavioral Problems (specifically, substance abuse)

Program information last updated on 5/7/07.

© Child Trends 2004